Sclerotherapy is the standard for the treatment of spider veins of the leg. Sclerotherapy is the injection of a substance (a "sclerosant") which when administered causes the vessel to collapse. Sclerotherapy agents include hypertonic saline, SDS and aetoxysclerol (polidocanol), Hypertonic saline, or a highly-concentrated salt solution.
Aetoxysclerol (polidocanol), is extensively used for sclerotherapy by dermatologists and plastic surgeons because it is safe, effective and well-tolerated. Lasers in general, can be more painful and are considered by most experts as being more risk-prone for potentially causing hypopigmentation and scarring.
Patients with protuberant veins may be a candidate for ambulatory phlebectomy, a procedure, which locally hooks and strips veins through a small incision or endovenous radiofrequency treatments.
Unsightly blood vessel or venous blemishes of the legs are usually very small, fine spidery or snake-like blood vessels running very close to the surface of the skin and have a very obvious red or purple-blue appearance. It is because of this obvious color, it cannot be covered with makeup, that make people want to remove these vessels.
The use of hypertonic salt (saline) solution has been a significant advance over the previously used materials, with lesser side effects in comparison with previous methods. Because salt is a natural body component there is not the concern for allergic reaction as there would be to previously used foreign materials. The salt is simply a stronger salt solution (23% NaCI) that will cause enough irritation of these little blood vessels to cause the vessel walls eventually to stick together, thus completely closing them off or partially closing them off. This results in either a very light color appearance to the vessels or complete disappearance.
Though not known clearly, the situation is obviously much more common in females. A familial predisposition, pregnancy, obesity, trauma, long periods of standing, sitting, etc. have been cited as possible reasons apart from hereditary tendency.
An injection of the solution is given with a very fine gauge needle. Fifteen to thirty seconds of mild discomfort or burning at the site of the injection may be experienced. Some patients may also experience a local muscle cramp which usually will only last a few minutes. A temporary flushing around the blood vessel which is expected in 100% of cases is seen.
The vessels will either lighten or completely disappear usually over the first month. In certain vessels, it may take as long as two or three months. Since many of these vessels interconnect, one injection may eradicate several dozen obvious blood vessels at one time. This is a distinct advantage of this method as opposed to methods that may treat isolated vessels at one time.
There is a chance that a small amount of salt solution will usually seep outside the blood vessel into the surrounding skin. This in fact happens to a small degree with all injection sites because we continue to infiltrate solution until a small amount seeps out. This tiny bleb that results in the skin usually heals quickly but may in some circumstances result in a small crust that may leave a small brown spot. This is not significant and will usually disappear, but in certain cases may leave a permanent small brown spot. In almost all circumstances this is much less obvious than the original blood vessels that were there. Some mild or moderate bruising may be seen depending on how fragile the blood vessels are. It may take a few weeks for them to clear.
A small coagulum of blood may develop at the injection site which becomes tender. This can gently be removed to relieve the inflammation.
A retreatment is done if vessels have not lightened after a period of 4 weeks. Depending on the extent, four to twelve sessions will help obtain a reasonable pleasing cosmetic effect.
After the procedure you will have multiple bandages on for 24 hours. You will be asked to wear an Ace-wrap or compression hose while awake for 1 week. One should refrain from doing any kind of exercise or strenuous activity for 2 days. Avoid exposure to sun for 4 weeks to avoid discoloration.
